The DC-10 flight on Garuda Airlines from Jakarta to Banda Aceh was fully booked. It was filled with locals returning home and scores of humanitarians - westerners mostly wearing khakis pants with the obligatory T-shirt, vest, or cap showing off their organization’s logo. Heck, it was the aid worker gathering of the decade and everyone was there. Although my arrival was more than two months after the Tsunami, a plethora of organizations were still visible. There were the UN folks: OCHA, UNHCR, UNICEF, WFP, FAO, UNFPA, and WHO: The military units from Germany, Spain, Pakistan, Japan, Australia, and the US: International organizations such as ICRC, IOM and IFRC with multiple national Red Cross/Crescent societies including Japan, Germany, France, Spain, and Turkey: Donor organizations such as USAID, Aus-AID, ECHO and JICA, and of course, the non-governmental organizations, NGO’s: MSF (Doctors without Borders), CARE, IMC, OXFAM, CRS, ADRA, MERLIN, MDM, AMI, Americares, Save the Children, World Vision, Islamic Relief, Action Against Hunger, Samaritan’s Purse, Mercy Corp, and plenty of smaller and lesser known groups. All in all hundreds of local and international NGOs have registered with the authorities. I was there with the IRC: The International Rescue Committee.

Initially on the drive from the airport there were few visible signs of destruction. As we headed into town at one point we passed a stripped and badly mangled car. I thought to myself that that must have been a bad accident. A few hundred yards later we passed another wreck. And then another. After passing four of these vehicles I began to understand what they were - they were what the locals call “Tsunami cars.” The force of the waves destroyed houses and buildings but also took cars and stripped them down to their frames giving them the appearance of having been placed in a junkyard compactor. These cars are scattered throughout the city. Some are now being striped for scrap; some just remain as monuments to the Tsunami.

Banda Aceh is the provincial capital of Aceh Province, the northern most province of the western Indonesian island of Sumatra. It was also the city hardest hit by the Tsunami. Before the magnitude 9.0 earthquake and subsequent Tsunami the population of Banda Aceh was about 400,000. It was a large, vibrant and fairly prosperous city. More than a quarter of the population died on the morning of December 26th.

Currently many parts of the city are getting back to relative normalcy. Colleagues who have been in town for a few months or even just a few weeks keep remarking about how much progress had been made in cleaning up the debris and the increasingly rapid return of businesses. During the day the roads are choked with cars, and hundreds of motorcycles and mopeds weaving in and out of traffic; each carrying two or three passengers and often small children or infants. The surgeon in me is horrified by the lack of helmet use. At night the markets are full of people shopping or eating out at the multiple food stalls, many with bright lights and large letters advertising “Nasi Goreng,” or “Mei Goreng.” Fried rice or Friend noodles.

But all is not completely back to normal. There are still multiple tent cities and IDP (Internally Displaced Persons) camps; and the government is in the process of building temporary housing for the hundreds of thousands of people made homeless by the disaster. These temporary shelters, termed barracks by some, are officially known as Temporary Living Centers or TLCs. I wonder what focus group came up with that one.

As with many other things in humanitarian assistance, the issue of these TLCs has become a controversial topic. Some aid organizations have refused to provide services for these facilities stating that the barracks are not in the best long-term interest of the local population. IRC’s current position is to support the water, sanitation and health facilities of these TLCs because it is the housing for thousands of people and there is a significant need for latrines, clean water and health services to limit the spread of disease.

In terms of overall reconstruction many homes are being rebuilt and shops and buildings restored to pre-Tsunami conditions; however, there are areas closer to the ocean where work is not being permitted. Local authorities are deciding about how to handle this area. For the moment no building will be permitted within 2 km of the water even though people have set up tents to reclaim their former property. The devastation, and that is really the only word that can be used to describe what parts of the city look like, is massive. There is a 2 to 5 kilometer deep area stretching along the coastline in which entire neighborhoods were completely washed away. And these were not bamboo huts on the beach. These were solid structures, one and two storey houses made of wood or concrete, well built and sturdy. They were completely swept away. Middle class neighborhoods, housing government employees and professionals were completely destroyed. Nothing remains. The scene reminded me of the pictures from Nagasaki or Dresden. Occasionally a single structure remains standing, damaged and listing, a single landmark in the midst of nothing. Level ground, all signs of other houses or structures just swept away.

When you speak to the locals, everyone has lost a relative or a few. A mother or father, brothers, sisters, children, or friends. But life goes on. People seem to be coping with the losses. They do not appear overly sad.

To understand some of the complexities of the situation here at the moment it helps to understand Aceh from a historical perspective. Aceh was an independent kingdom and strong trading nation until the mid-17th century. In 1871 war was declared between the Acehenese and the Dutch. This war lasted for 35 years and resulted in many deaths on both sides. In 1951 Aced was incorporated into Sumatra as part of Indonesia. With differing traditions and mostly Islamic religious beliefs, the Acehenese pressured Jakarta for a more independent status and ultimately received greater autonomy. One problem, however, was that the revenue being generated from the massive natural gas reserves were not being shared with the local populace.

In 1976, the Free Aceh Movement (GAM) began operations in an effort to gain Aceh’s independence. The conflict simmered for years but became increasingly violent with atrocities committed by both GAM and the Indonesian Army (TNI). For much of the 1990’s Aceh was under military rule. Peace talks were undertaken, but little progress was made.

After the Tsunami the conflict between the TNI and GAM has markedly quieted down; however, there is still some underlying tension. Occasionally reports circulate about small incidents between GAM and the TNI. In Banda Aceh itself none of this tension is readily apparent and although there is a sizeable TNI presence; I actually expected to see more soldiers.

Out in the other districts things are a bit different. At this point aid workers have not specifically been targeted and both sides have agreed to let the international community undertake reconstruction efforts. Throughout the districts are multiple TNI checkpoints and although most of the time we are just waved through by smiling guards wearing shorts and T-shirts; we do roll down the tinted windows to let the soldiers have a clear view into our vehicles.

But overall things are relatively safe - considering the fact that before the Tsunami this was technically a conflict zone. One of the things I have been involved with in the past few weeks is assessing the main hospitals and evaluating their capacity to potentially stabilize an injured staff member. I have been pleasantly surprised by the local hospitals, surgeons, the way things were reequipped, and the ability to deal with trauma. Sure I think that medevacing someone to Singapore would be the best option, however, sometimes really sick people need to be stabilized first.

Another issue that at times is a bit disconcerting is the earthquake after-shocks. The biggest ones so far have been 6.0 and a 6.1. No damage or injuries were reported. Having never experienced an earthquake before it’s certainly strange to feel things moving and hear the house shake. But luckily all has been OK.

Another first for me was getting a ride in a helicopter. IRC had rented a helicopter to assist with transport between our four field sites: Banda Aceh, Meulaboh, Lhokseumawe and Calang. Given that the road along the west coast of the province was severely damaged helicopters are very helpful in moving staff and some equipment. The ride was great; we flew along the coast from Banda Aceh to Meulaboh and certainly gained some better insight into the magnitude of the damage. It was incredible to see how far inland the waves had gone. A sharp line marked the limit of the water damage and everything between the ocean and this line was a brown-grey. Roads were destroyed; concrete slab foundations were all that remained of houses and communities; trees were uprooted and splayed on the ground. We flew over tent cities that had been erected on higher ground adjacent to destroyed villages.

One of the towns we flew over, Calang is in the district of Aceh Jaya. This was a town of about 10,000 people prior to the Tsunami. It is especially of note because it was completely destroyed. More people were killed in Banda Aceh (estimates are over 100,000) but by percentage this town was one of the hardest hit; it is estimated that approximately 6,000 people died in Calang. In addition, almost every building and house was destroyed. No infrastructure survived and many aid organizations are currently helping with the reconstruction efforts; and even now things are still pretty bad. In fact, the IRC team is still living in tents. But on a positive note, the Norwegians have erected a restaurant of sorts and the food is free. I am told that many of the westerners gather there for breakfast and dinner. They bake fresh bread and have lots of food in cans and tubes. There is even tube caviar. Go figure.

Before my flight to Meulaboh I spent almost two weeks in Banda Aceh. My role there was to assist the health coordinator in tying up a few projects. I was tasked to work with some of the local staff to complete an inventory of donated medications and get these to the Ministry of Health; work with a local nutritionist in developing a plan to evaluate and treat nutritional problems of villagers in a local sub-district; set up a conference so that the entire health team could meet in Banda Aceh and discuss future strategy; assist the field team in Aceh Besar with their work; and I also began work on training the IRC drivers in basic first aid.

I am currently working in Meulaboh, the second largest city in Aceh province with a population of 120,000 prior to the Tsunami of which an estimated 30,000 people died. IRC arrived in Meulaboh relatively late after concentrating in other regions. Because of the large number of aid organizations already working in the district of Aceh Barat we are concentrating our work in the adjacent district of Nagan Raya. That district now has a total population of about 120,000 and covers an area of approximately 4000 square km. In terms of health care we are involved in reequipping the ten public health centers (puskesmas) in the district. Throughout Indonesia there is a relatively good health care infrastructure which places a great deal of emphasis on public health and primary care. In Aceh prior to the Tsunami the health system had limited capabilities due to neglect secondary to the conflict.

In theory the health care system originates with groups of volunteers called cadres who live and work in each village. These volunteers function as informal community health workers and provide basic health information to the population and report directly to the village midwife. Each village should have a midwife who works out of a midwife hut (posyandus). The posyandus are the sites for initial care and from there patients are referred to the puskesmas where there is usually a doctor and a few nurses. Each puskesmas serves roughly thirty villages. The puskesmas should have laboratory services, limited instruments, medications, and beds for one or two inpatients. Cases that are more complex are referred to the district or provincial hospitals.

My role here in Meulaboh is to continue the program initiated by an Australian ER doc, Kate, who did an assessment of all ten puskesmases in Nagan Raya. Kate put together a detailed list of the equipment needs and we are now in the process of obtaining the price quotes. It will be my responsibility to continue with the procurement process and also to continue teaching sessions with the doctors, midwives, and nurses at the puskesmases. We have a schedule where almost every puskesmas will be visited once a week and I will give them talks on topics ranging from diarrhea and the management of the sick child to wound care and possibly a suturing lab.I must admit this is the strangest relief operation I have ever been associated with. However, at this time it really isn’t an emergency relief operation. The government has officially declared that the emergency phase is over and that work is to start on reconstruction and rehabilitation. We have moved out of the crisis phase and are looking to be more involved in development work.

For some of us it’s really amazing to see all the effort and money that is going into the relief effort here in Aceh. Many of us have worked in other countries, especially in Africa, where the need is much worse. We have been lucky that there have been relatively few deaths after the Tsunami and that there have been limited outbreaks of infectious diseases. In part this has been because of the enormous response by the international community. Many of us, however, often talk about the unrealistic hope of transporting some of the donated supplies to Africa. I don’t want to even imagine the number of people dying every day in countries such as Malawi or Sierra Leone. But the fact remains that we are here to help the people of Aceh and the money that was donated to Tsunami relief, belongs to the people of Aceh.

Just so you all don’t think I am suffering too much, we have been able to get to the beach a few times for some swimming. Also the food is pretty good. A lot of rice, chicken and fish, curry sauces and chilies. The food is not as hot as Thai food but still very good.

I must admit it is very nice working for a big organization. In the past I have been used to doing things on my own or with small groups. With IRC we have guys who work out the logistics; we staying in nice houses and overall things are relatively comfortable.

Well, that’s all for now on this lazy Easter Sunday. We are off to the beach.

I'll be in touch,

Adam

Indonesia Update #2

Well, this update is a bit like sending out postcards after arriving back home; and yes, although most of this was written in Indonesia (Bali to be specific), I am currently back in the U.S. So then I guess the question is; what have I been doing since the last update? And the answer is lots. However just so you know, this update will focus mostly on the emergency response to the March 28, 2005, earthquake. It’s amazing how much work an 8.7 earthquake will generate in a place that has already undergone a 9.0 earthquake and a Tsunami. Let me also say, it amazing how one’s perspective can change. Before coming to Aceh and never experiencing an earthquake, a 5.0 or 6.0 seemed like a pretty big deal. Well, having now felt an 8.7, I’ve gotten to the point where the 5.0s don’t even warrant getting out of bed; they’re just small aftershocks - nothing serious.

The earthquake of 28 March, however, was serious business. At 11:15 p.m., after having just gotten into bed for the night, I felt everything begin to shake. Now ordinarily the aftershocks last only a few seconds and then stop. This was different. Not only did the bed shake, it just didn’t stop. I got out of bed, threw on some pants and staggered out of the house. Staggered is really the only way to describe it. The ground continued to move and bounce up and down. It was as if you had some sort of balance problem and couldn’t stand straight. All the other expats and our guards were standing in front of the house in the pouring rain. Creaking from the house made us all uneasy as we waited for things to stop. I’m told the quake lasted for about 3 minutes, but it really really seemed much longer.

Once the ground stopped moving we sat on the front porch, assessed the situation and tried to come up with a plan. The locals who lived in the neighborhood didn’t hesitate. They had already experienced one Tsunami and were high-tailing it to higher ground. Within minutes the roads where choked with cars and motorcycles and masses of people leaving their homes or tents and seeking shelter elsewhere.

Shortly afterwards we received a message from Tom, our field coordinator, that everyone at the office was well, but that there were rumors of casualties at the local hospital. An Australian ER doc and I went to check things out.

When everything settled down the next day, we learned that a few buildings had collapsed, a few dozen people had been injured, and three people had died. However, that night on arriving at the Emergency Room we only saw one patient with relatively minor injuries. The main problem was that most of the hospital staff and doctors had fled. Many patients and their families, if they could, fled as well. No one was going to the hospital; they were all fleeing to higher ground. When we arrived only Dr. Harris, the hospital director who we had previously met, was holding down the fort. He was certainly happy to see us even though we were not immediately needed. We left directions on how we could be contacted and went back to the IRC office. The following day when I went back to the hospital to check on things, Dr. Harris was still there; although by that time supported by other medical personnel from the Indonesian Red Cross (PMI).

That night the IRC office was jam-packed with local staff and their families. Dozens of people were sitting or lying on mattresses on the floor. Some were trying to sleep; but most just stared blankly and quietly into space. These were people who had already suffered from the Tsunami of December 26th. They were scared and tired.

After a few hours, as it became clear that there would be no ensuing Tsunami, people gradually left the office and returned to their homes. I dozed on a small couch. By 5 a.m. only a handful of people remained.

Since we had a generator and a satellite connection; we had internet access. Early the next morning Tom and I began scouring the web; searching for news about the quake. Initial reports came out of the Island of Nias, about 250 kilometers south of Meulaboh. Slowly we began to formulate a plan. We were the closest IRC field office to the epicenter of the earthquake; we had a warehouse full of tents, tarps and blankets. We had boxes of emergency medicines. We felt obligated to try and do something.

Initially we considered hiring a boat and going to Nias but we quickly realized that such a trip would be risky and take well over 20 hours. We eventually came across reports about the coastal town of Singkil. The reports indicated significant earthquake damage and a small Tsunami. We learned that access to Singkil would be difficult; the main road was severely damaged and impassable. A boat trip was looking to be inevitable.

Now let me just explain one thing. In rereading the above paragraphs it almost seems like this was an easy decision to make. Well, it really wasn’t. We were dealing with very limited information about an area we didn’t know. We were able to print out a few maps and even used a Lonely Plant guide book for some info. Tom and I and the other staff went back and forth on our decision and plans. The bottom line was, an 8.7 earthquake, one of the largest in the last 100 years had occurred nearby and it just didn’t seem right to sit around and do nothing and wait for additional information to filter in. We knew we were taking a risk. It was a calculated gamble; but it seemed worth it.

The earthquake had occurred late Monday night. By Tuesday afternoon we’d sent a truck carrying five tons of emergency supplies to the town of Tepak Tuan (TT as I called it because I could never remember the actual name). The driver was instructed to locate and hire a fishing boat big enough to transport us to Singkil. Wednesday morning at 7 a.m. Tom, Pranto (an Indonesian nurse), Techu (an Indonesian logistics officer) and I left for TT. The six hour drive was uneventful and the road was in relatively good condition.

TT is a lovely coastal fishing town with a Mediterranean feel. Both of the earthquakes and the Tsunami caused minimal damage and the town’s brightly colored buildings and interesting architecture remain intact. We spent a few pleasant but impatient hours there while organizing our transport. Unfortunately, the boat that the driver had located didn’t work out. The owner didn’t have the proper paperwork and was charging way too much. Our initial plan was to hire the boat for three days; transport us and the supplies to Singkil, wait while we did our assessments and distribution, and then take us back to TT. When that plan didn’t work we managed to find another boat owner and captain who was willing to transport us one way to Singkil. We decided that this would work.

While waiting for the boat to be loaded we met the local Indonesian Army (TNI) commander. The reports he received from Singkil indicated that about half the houses had been destroyed, that the main road was impassable, and that there were many injuries. We grew more and more impatient.

We finally left TT at about 6:00 p.m. The fishing boat, painted a muted aqua with red trim, was the typical large wooden design common throughout the region. We were able to easily load all of our supplies onto the deck and join the other passengers, goods and crew.

Once underway, we each claimed a small section of the deck and spread out on the bundles of tents and plastic sheeting and relaxed as the sun set. The water remained calm and although the temperature dropped and there was a threat of rain a few hours after midnight, we arrived safely and without incident. The trip took about eleven hours but just before reaching Singkil we had to weigh anchor and wait for sunrise. The town is on the banks of a river and the captain wanted to assure a safe landing. We eagerly awaited the dawn.

Slowly we traveled up the river, passing a few flooded houses and some small fishing boats. The river was muddy, swollen and full of debris. We later learned that in some places the ground had dropped by as much as three feet. We finally landed at Kilangan: the western end of Singkil. Hundreds of villagers were out to meet us. There was a sense of solemn excitement in the air. Children stared but were quite. We waved and a few people waved back. Everyone seemed relieved and very happy to see us.

We spoke with some local leaders and they guided us through the flooded streets of the village. We waded past scores of uninhabitable houses; a few were badly damaged and falling over, but most were flooded by a few feet of water. We then walked past the local market and bus terminal which most of the villagers were using as a temporary shelter. Further on we saw a large group of people who were living in a mosque.

As it turns out, the mosque is a mausoleum of a holy man who is credited with bringing Islam to Aceh. One story we heard was that during the earthquake people either ran to the river expecting to die, or ran to the mosque hoping to be saved.

Near the mosque we sat with the village leaders and tried to learn as much as we could about what happened and the current conditions. The information we obtained was that approximately 1,600 people from three villages, Kilangang, Kuala Baru and Kaya Menang were staying at the market, the bus terminal, and the mosque. They reported few deaths or injuries from the earthquake, but many of their houses were uninhabitable; food was in short supply; the river was being used both as a source of water and for sanitation.

While Tom and I were doing this initial assessment with Pranto as our translator, Techu found a temporary warehouse and off-loaded the supplies. We made arrangements with the village leaders to have a distribution later in the day. We had enough supplies to give two blankets and one plastic sheet to every household. We agreed to return at 2 p.m.

At this point we split-up. Tom and Techu borrowed motorbikes and went in search of the Bupati, the district leader. Pranto and I walked what we were told was the one kilometer to the local hospital. Well, first of all it wasn’t one kilometer, it was more like three or four and there wasn’t actually a functioning hospital. It was in the process of being built, but we did manage to find the health center next door. Along the way we saw many flooded houses, damaged roads and bridges, and downed utility poles.

At the health center we spoke to a nurse and asked about injuries and if they were seeing a large number of patients. We were told that before the earthquake they would typically see 30 to 40 patients a day and maybe of those 10 would have diarrhea. After the earthquake they were seeing less than 10 patients a day. We were told that many people, including the doctor, had fled to Remo, a town about 45 minutes away. I wanted to get to Remo; however, first we had to find Tom and Techu, and also meet the IRC helicopter which was arriving at 11 a.m. with additional staff.

Pranto and I got a ride to the Bupati’s office; we didn’t see Tom and Techu, but instead were introduced to Mr. Hassan, the assistant Bupati and chairman of the local Indonesian Red Cross (PMI). We were told that there had been only a few injuries in Singkil, but that additional doctors might be needed in Remo. Mr. Hassan offered to bring us to the PMI office; however, as we climbed into his car, we heard the helicopter overhead. It landed in a nearby soccer field. As we drove up we saw Tom and Techu.

On the helicopter were two expats and two local staff: Valerie, an IRC doctor, Greg, the IRC information officer, Adi, an engineer and senior logistics manager, and Ucak, a civil engineer and our water and sanitation guy.

My biggest concern at that moment was the question of injured people in Remo. We ended up hiring a truck to take us to the village and were able to meet with many of the Internally Displaced Persons (IDPs) and the local doctors. We were told that there had been 11 deaths and as many as 50 injuries immediately after the earthquake, but most of the injuries were minor and things were under control. We also tried to get a better handle on the number of IDPs. We were told that immediately after the earthquake there were more than 2,000 IDPs in Remo, five to six hundred living in government supplied tents erected on a soccer field, the rest living with friends and relatives. Many IDPs, we were told, had started to return home; but some were spending nights in Remo and going back to their villages during the day. At that time we were using a total figure of about 2,000 – 3,000 IDPs for the entire district. That number was ultimately to increase by a factor of ten.

We drove back to our temporary warehouse in Kilangan and began the distribution. As the crowds gathered we began to see some people with minor injuries. Before we knew it there was a line of about 40 people all waiting to be seen and more and more kept showing up. As none of the villagers looked critically ill, we had Pranto, the nurse, do the triage. The non-urgent cases were referred to the health center; Valerie and I saw the sicker patients. We ended up treating over 30 people, mostly for skin infections, diarrhea and small cuts and bruises. We dispensed some medicines, bandaged the wounds, and instructed people to go to the health center in the morning. The last thing we wanted to do was create a parallel system that would in the long run undermine the local health services. This spontaneous clinic was to be a one time deal. (By the way, it also got my picture on the IRC website.)

At 7 p.m. after the distribution and the clinic we sat down to our first meal of the day and finalized a plan. Given that things seemed relatively under control for the moment, a decision was made to leave a small team in Singkil to continue with assessments, begin building emergency latrines and wells, and support the local health system. Later that night, Tom, Greg, Valerie and Techu left by boat and returned to TT. Adi, Ucak, Pranto and I were left to continue the mission.

Now when I was hired to come out to Aceh is was to be in the capacity of a public health worker; I figured that even though I was a surgeon, I could teach malaria and diarrhea if I needed to. One thing I never expected was to be the team leader for an emergency mission to help provide for thousands of IDPs. It was a little scary. Sure I had led teams in the field before, in Kosovo and Azerbaijan and Iraq , but this was a much bigger deal. Tom smiled and told me not to worry as he signed over 25 million rupiah (US$2,500). We said our goodbyes, and the team and I went to a local hotel.

The story of the emergency response in Singkil is really about team work. In some ways it turned into a perfect mission but that was due to two factors: a great team and the lack of other international NGOs. As you can imagine, with me being but a simple surgeon, without much knowledge of water and sanitation, logistics and the local language, it would have been difficult for me to accomplish very much on my own. But as a team we did rather well. The lack of other NGOs also eliminated problems with coordination and competition.

From the beginning I want to say that my role in the success of the mission was minimal. It was really the other guys who did all the work. I helped a bit with the coordination and organization and with meeting the local officials, but Adi, Ucak and Pranto deserve all the credit. Let’s face it, I can’t even speak the language, let alone know how to build a latrine.

What we ultimately learned was that there were more than 30,000 IDPs at 26 sites throughout the entire district. The International Committee of the Red Cross sent two assessment teams and eventually delivered some tents, and the International Organization of Migration delivered some food. But during the time I spent in Singkil, we were alone.

However, during that time we managed to partner with a local NGO, hire logistics and health field monitors, secure a more permanent warehouse, receive and distribute another large boatload of non-food items including: more blankets, plastic sheets, hygiene kits, kitchen sets and a large water bladder. We also distributed medicines to the health center and other health posts, constructed latrines and wells at the IDP camps, distributed water purification tablets and oral rehydration salts (ORS). On the health side, we recruited 20 community health workers from the local villages and IDP sites and trained them on how to teach about hygiene, diarrhea, ORS, and when to refer sick people to a health center. We also began to collect surveillance health data from the communities and the health center. An IRC education team also arrived; they visited damaged schools, agreed to help provide emergency school tents, and possibly begin rebuilding some of the more than 30 schools destroyed during the earthquake.

During our stay in Singkil, we also had a great time. We started each day at a local restaurant with a breakfast of mei goreng (fried noodles) and kopi (coffee). It was also our daily team meeting. All decisions were made as a team. Everyone offered an opinion; all decisions had to be agreed upon.

The Centa Saudara hotel became our temporary office and living quarters. We raised an IRC flag in the front yard. After three days, an IRC car and driver (Harry) were sent from Medan . When driving around town I would hear a non-stop chorus of “Hallo Mista,” see children running after the car and waving, and older people smiling. The owner of the hotel was an old guy whom I dubbed, Mr. Magoo. Before our own car arrived he drove us around town a few times; he had thick glasses and never drove faster than 20 mph and insisted on playing tapes of quick tempo Indonesian pop. He was a real character.

Another character was Ringo, the district police chief. Ringo’s last name was really Siringo, but as he told us in his passable English, “Everyone calls me Ringo, like Ringo Starr.” He told us that he only sang Beatles songs when he did Karaoke and was very interested to hear that Paul McCartney had donated a large sum of money to the IRC for Tsunami relief. One night Ringo showed up at the hotel and chatted with us and Mr. Magoo for a few hours. He stopped visiting, however, after a large 6.5 aftershock. When I asked him why, he expressed to us what many people in Singkil felt; fear about another large earthquake and a Tsunami.

Everyone in the area had heard about “the experts” who were making predictions about the next big one. Many people began sleeping in the IDP sites at night and refused to stay in their houses and their villages. This fact began to make the entire relief operation a bit more difficult. It’s hard to get an accurate picture on the scope of the problem if the number of IDPs kept changing. Do you count someone whose house is fine, but they are too scared to live in it as an IDP? We decided that we would.

Another person we had a good deal of contact with was Lieutenant Colonel Ilyas. He was the district military commander (Kodim) and was the TNI officer responsible for coordinating the local relief effort. Every night at 8 p.m. he held a coordination meeting. Now this was all well and good, however, there were two slight problems: first, the office was a 25 minute drive out of town (they had recently built a new headquarters on higher ground) even when Mr. Magoo wasn’t driving; and second, on most nights no one else showed up. But we kept showing up every night at 8 p.m. As we were the only international NGO there wasn’t much of a need to coordinate with other NGOs, but Lt. Col. Ilyas, when he was in town, seemed to enjoy meeting with us. On my last night in Singkil we actually met in his house; during the day he had given me hand drawn maps from all the sub-district leaders as to where to build latrines and wells. At 8 p.m. I went with Ucak and our local partner to discuss some of the details. The meeting was all in Bahasa (the common Indonesian language); I just sat there and drank tea. I mean, what use was it to double the length of the meeting with translations into English for a surgeon who doesn’t understand water and sanitation anyway.

Our days usually ended with dinner at about 9 p.m., after the meeting with Lt. Col. Ilyas. We mostly ate at a small restaurant near the hotel which basically served the same thing every day: rice and fish. That was, however, on the days they had rice and fish. Some days they didn’t, and so we had instant ramen noodles and maybe fried eggs. We would sit around and eat, discuss any problems and make a tentative plan for the following day. We also got to watch some TV; Indonesian idol was by far our favorite.

One of the highlights of the mission was the day we spent assessing some of the surrounding villages. One morning after breakfast we set out to visit Teluk Ambon, Kuala Baru and Kaya Menang. Each of these towns was situated on the banks of the river and had suffered significant earthquake damage. To visit these places we hired a large wooden canoe with an outboard motor; the typical means of transport. For over an hour we traveled up small arms of the river, through tunnels of jungle, and past floating debris. It was another “Heart of Darkness” moment.

Teluk Ambon was completely flooded and of the original 650 inhabitants, 200 were living on boats; the rest were living in a makeshift camp in one of the Singkil markets. They reported a lack of latrines, an increase in diarrhea cases, and the death of a two month old girl. We made it a priority to get them water purification tablets and ORS.

Kuala Baru is a village of 2,500 and is located on a narrow strip of land between the river and the ocean. It got hit from both sides; flooding because the land on the river-side sank, and by a small tsunami on the ocean-side. Of the 400 houses in the village, about 100 were severely damaged. Offsetting the destruction were the bright reds and yellows of the locally embroidered cloth hanging out to dry. Afterwards we sat with the village leaders and learned that a two year old girl had died the previous day from complications of severe diarrhea. We left ORS and other medicines at the health post and promised additional supplies. Over the next few days we delivered a number of tents and blankets and later hygiene kits and kitchen sets. During the visit we also met the local TNI commander; unlike other officers he was not over excited to see us and seemed more concerned with issues of security. Before the earthquake this sub-district had been a relatively less secure sector.

In the last village we visited that day, Kaya Menang, things were a bit different. The houses, made of wood, were built on short concrete stilts. The earthquake had knocked many of the houses off their stilts, but did not destroy the actual structures. What was destroyed were the villager’s fishing boats and fishing nets. The houses mostly looked livable, but without a livelihood and with the fear of further earthquakes; the village was nearly abandoned.

When the Singkil operation was running smoothly another Indonesian staff member from Banda Aceh relieved me. Pranto and I flew by helicopter back to Meulaboh. Once back I resumed the work of equipping the ten health centers throughout the district of Nagan Raya. A previous assessment had identified the needs and we were in the process of procuring what was necessary for the care of the local population.

Anyway, those are some of the highlights from Aceh. I was fortunate to be there during a time of transition; transition from the emergency stage to one of rebuilding and reconstruction. I think that the local population is beginning to recover from the initial shock of the Tsunami. The Acehenese are very industrious and intelligent people and I am glad that they are taking a more active role in the rebuilding process. The international militaries have all departed. In one of the destroyed areas of Banda Aceh on a partially destroyed building was the spray painted words, “GO HOME.” Aceh initially needed the international community and people are extremely grateful for the assistance, but they seem increasingly determined to do things themselves. It will be interesting to see what happens over the next few months and years.